This is something I guess everyone struggles with, and it's all about finding a BALANCE, but just how do we find that perfect union between being effective without being time consuming?
At my last prac in musculo outpt's I was criticised for poor time management skills as I was initially taking between 1hr to 1.5hrs for an initial consultation. Now it seems that the notion of time management is fairly variable across facilities. Having talked to various people at different facilities, 1-1.5 hrs can range from being deemed acceptable to highly unacceptable. Obviously as you build clinical experience it is easier to hone assessments in to become more time efficient. I guess my question is, would I still be able to effectively treat my pt if I did only half of my assessment? I think the answer is no! I would probably be much more inclined to jump to assumptions about a pt, which could often be wrong, as I don't have the clinical experience to make appropriate assumptions without actually assessing. And as students, we are keen to not miss anything out in case our supervisor asks us about it, so hence comes the difficulty to treat effectively in a minimal amount of time. Does anyone have any advice on how they manage this often stressful predicament??
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Hi Rach,
I was actually talking about this today with lil. At my last placement SPC rheumatology I was also treating patients in the Musculo outpatients when I was not busy in the wards. Here we were expected to have completed the initial Ax, Rx, HEP or hydro referal n got the pt out the door with paper work finished in 1hr... Well at least thats what we were trained up to do. However, currently at Curtin clinic we are expected to utilise the whole 1.5hr time slot to complete the initial Ax and there is no pressure to complete paper work in this time. I find both situations beneficial in diff ways. At SPC it was more like a PT situation. You are expected to use your clinical reasoning skills to prioritise the Ax tools u would use in the initial session and then just state in your plan the further Ax u will carry out. For example, someone w LBP and radiating LLP; choose posture/ gait Ax, neuro Ax, screen AROM Lx and do hip quick tests to see where the pain source is. Then direct ur Rx from this if u can (basic HEP/ edu/ mobs...) and put in plan to further Ax Lx or hip or even look at SIJ e.t.c whatever u feel is indicated. So u might not be totally sure of the Dx but can exclude probs n be suspicious of others. It can be finalised later, n often generally Rx symptoms by posture edu, stretches, heat/ice e.c.t. explain to pt that next session will focus more on Rx and gaining the whole picture... However at curtin clinic you have the time to really be thorough and complete everything, sometimes you may spend 2hrs with a pt if thats what you need to get a Dx. Then the follow up is 1hr also so u can perform lots of techniques so this situation is good 4 prac techniques... My attitude is do what u can in the specified time frame, abuse the whole Rx is guided by Ax so dont assume specifics!... I dont feel stressed about starting global then going specific when I can? kinda focus on pt edu and explain everything as I go so they kno the drill... But thats the thing diff supervisors have diff expectations so it may be harder at Bentley to have this sort of approach?... blah, blah, blah, ne 1 else have more concise thoughts, ha, ha...
Hey Rach,
That sounds so hard!! Sounds like you did really well considering the expectations! I dont really have any advice as to how you could handle the situation... I have terrible time management as you can probably tell by the lateness of this post! Im on prac with Kym so we have 1.5 hours for initials and 1 hour for follow ups and can do our paperwork outside of this time. It makes it so much easier and we have time to discuss Ax findings, Rx choice etc with our supervisors before we continue with Rx. I think its really up to the uni to sort out this problem of inconsistent expectations between the placement venues. Its great that you are able to treat the pts in less time now, but i think there should maybe be some guidelines for the supervisors telling them we ALL need 1.5 hrs for initials in week 1/2, then cut down 15 mins each week or something?? Maybe we could approach the year reps?? ;)
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